AB1477 MEDIAN 0-10 PATIENT GLOBAL ASSESSMENT WAS 2.5-5 POINTS HIGHER IN INFLAMMATORY ARTHRITIS PATIENTS POSITIVE VS NEGATIVE FOR FAST4 (FIBROMYALGIA ASSESSMENT SCREENING TOOL) AND/OR MSD2 (MDHAQ DEPRESSION SCREEN): 2 EASILY-SCORED MULTIDIMENSIONAL HEALTH ASSESSMENT QUESTIONNAIRE (MDHAQ) INDICES
Authors: T. Li, K. Gibson, T. Pincus, J. Schmukler, R. Morlà, G. Luta
Journal: Annals of the Rheumatic Diseases (2022)

Background Patient global assessment (PATGL) is included in DAS28, CDAI, ASDAS, DAPSA, and other indices to assess rheumatoid arthritis (RA) or spondyloarthropathy (SpA). PATGL reflects inflammatory activity in many patients, but may be elevated by comorbid fibromyalgia (FM) and/or depression (Dep), which are often unrecognized in others, complicating interpretation and use in treat-to-target. A 2-page multidimensional health assessment questionnaire (MDHAQ) includes PATGL and two easily scored cumulative indices, FAST4 (0-4 FM assessment screening tool) and MDS2 (0-2 MDHAQ Dep screen), which agree more than 80% with reference 2011 revised FM criteria, HADS-D and PHQ-9, 1-3 and may clarify interpretation of high PATGL and index scores, particularly in busy clinical settings. Objectives Analysis of PATGL in patients with RA or SpA according to MDHAQ FAST4 and/or MDS2 positivity (+) or negativity (-). Methods MDHAQ was completed at a routine care visit at 3 sites in Australia, Spain, and USA. Medians and interquartile ranges (IQRs) for PATGL were computed for RA and SpA, according to FAST4 + or – and/or MDS2 + or -. Differences between medians of PATGL with 95% confidence intervals (CIs) for FAST4 and/or MDS2 were estimated from median regression models that included FAST4 and MDS2 for each setting, and setting for pooled analyses. Results Among 393 RA and 175 SpA patients, 23.0%-32.7% were FAST4+ and 29.4%-36.7% MDS2+, with 41.1% positive for either FAST4 or MDS2 (data not shown). PATGL medians were 4.8-5.0 in all RA and 3.0-6.0 in SpA, 2.0-3.0 in FAST4-/MDS2-, 5.5-6.0 in FAST4-/MDS2+, 7.0-7.5 in FAST4+/MDS2-, and 7.0-8.0 in FAST4+/MDS2+ patients, similar in RA and SpA at 3 settings in 3 continents (Table 1). Adjusted median differences were 3.0–3.5 for FAST4 + vs - (twice the level for FAST4 -, MDS2 -) and 2.0–2.5 for MDS2 + vs - groups (Table 1). Table 1. Median scores and interquartile ranges for PATGL according to positive or negative FAST4 and/or MDS2 Primary ICD10 diagnosis Total FAST4 NEG MDS2 NEG FAST4 NEG MDS2 POS FAST4 POS MDS2 NEG FAST4 POS MDS2 POS Adjusted median difference (95% CI) (FAST4 POS – FAST4 NEG) Adjusted median difference (95% CI) (MDS2 POS – MDS2 NEG) Three sites pooled n=518 n=305 (58.9%) n=71 (13.7%) n=50 (9.7%) n=92 (17.8%) RA 355 3.0 (1.0, 5.0) 5.5 (3.6, 6.5) 7.5 (6.5, 8.5) 8.0 (7.0, 9.0) 3.5 (2.8, 4.2) 2.0 (1.4, 2.6) SpA 163 2.5 (1.0, 5.0) 6.0 (4.0, 6.5) 7.3 (6.8, 8.5) 8.0 (6.5, 10.0) 3.0 (2.1, 3.9) 2.5 (1.5, 3.5) Australia n=257 n=155 (60.3%) n=35 (13.6%) n=22 (8.6%) n=45 (17.5%) RA 182 3.0 (1.0, 5.0) 5.5 (4.5, 6.5) 7.5 (7.0, 8.0) 8.0 (7.0, 9.0) 4.0 (3.0, 5.0) 1.5 (0.5, 2.5) SpA 75 2.5 (1.0, 5.0) 4.5 (2.0, 6.8) 9.0 (7.0, 9.5) 8.0 (7.0, 8.5) 4.0 (2.2, 5.8) 1.0 (-0.8, 2.8) Spain n=169 n=90 (53.3%) n=27 (16.0%) n=18 (10.7%) n=34 (20.1%) RA 101 3.0 (1.0, 4.5) 5.5 (3.6, 6.8) 6.0 (5.5, 7.0) 8.5 (8.0, 8.5) 3.0 (2.1, 3.9) 2.5 (1.7, 3.3) SpA 68 3.0 (0.8, 5.0) 6.5 (6.0, 7.0) 7.3 (6.5, 8.0) 7.5 (6.5, 10.0) 3.0 (1.1, 4.9) 2.5 (0.9, 4.1) USA n=92 n=60 (65.2%) n=9 (9.8%) n=10 (10.9%) n=13 (14.1%) RA 72 3.0 (1.0, 6.0) 6.0 (3.5, 7.0) 8.5 (8.0, 9.5) 7.0 (7.0, 9.0) 5.0 (2.7, 7.3) 1.0 (-1.3, 3.3) SpA 20 2.0 (1.0, 4.5) 2.0 (1.0, 3.0) 7.0 (7.0, 7.0)* 8.5 (5.5, 10.0) 5.0 (0.5,10.5) 0 (-3.3, 3.3)* NEG = negative, POS = positive, NA=Not available (No patients or the adjusted median differences cannot be estimated due to the small number of patients), *=Only one patient in category. Conclusion Median 0-10 PATGL was 2-3-fold higher in 41.1% of RA or SpA patients with positive MDHAQ FM and/or DEP screening indices vs 59% with 2 negative indices. Differences were greater according to FM than Dep. MDHAQ may clarify interpretation of PATGL and indices, including in treat–to–target, using a single, brief, feasible questionnaire in research and busy clinical settings. References [1]Schmukler et al. ACR Open Rheumatol. 2019;1:516-25. [2]Gibson et al, J Rheumatol. 2020;47:761-9. [3]Morla et al, Arthritis Care &amp; Research. 2021;73:120-9. Disclosure of Interests Tengfei Li: None declared, Kathryn Gibson Grant/research support from: Dr. Gibson has received honoraria from UCB, Novartis, and Janssen and grants support from Novartis., Employee of: Dr. Gibson is a part-time employee of Eli Lilly but no financial or other support was received from Eli Lilly in the creation of this abstract., Theodore Pincus: None declared, Juan Schmukler: None declared, Rosa Morlà: None declared, George Luta: None declared